SSRIs-Worth the Risks?

[Nocd39]

I’ve just been listening to this podcast about SSRIs with Dr Rangan Chatterjee and Joanna Moncrieff:

https://podcasts.apple.com/gb/podcast/feel-better-live-more-with-dr-rangan-chatterjee/id1333552422?i=1000712300093

It’s a really interesting listen and they discuss research on how SSRIs work (basically we don’t know), whether they are effective, and side effects.

I think it’s pretty worrying that we still don’t understand how the drugs work when there can be serious and ongoing side effects. I wish there was more research into alternatives. And more non-medicinal support for people who are struggling.

AIBU?

There is lots of research out there for other therapies, as well as pharmaceuticals but the problem is that mental health is very difficult to measure in absolute terms and also many papers for alternative non pharma therapies are underpowered i.e. insufficient participants and / or difficult to measure the placebo effect. Having read lots of these despite the shortcomings the overriding theme is that alternative treatments perform better when prescribed alongside pharmaceuticals , alternative therapy in isolation indicates very mixed results and they certainly do not perform as well as pharmaceuticals.

As a previous poster said best practice is to prescribe medication alongside other therapies.

I would welcome your view given your medical background, but I have been told (by my psychiatrist) that there isn’t any solid research into the likelihood of some of the more severe side effects such as sexual dysfunction, which can be ongoing or even permanent for some people. Same with issues on withdrawal effects, which can be severe and it can take months to wean off if you’re unlucky. Much of the current research, as I understand it, is based on people taking SSRIs for short periods whereas we know many people take them for months or years. Unfortunately, in my experience other options (therapy) take much longer to access than medication.

There is definitely research going on, the antidepressant market is worth an absolute fortune to the pharmaceutical industry. Sadly brain physiology/pharmacology is complex and sometimes there just isn’t an easy solution.

Therapy or development of other treatments which could be alternative drugs (I think there are some trials on psychedelics now?) or other non surgical interventions such as TMS. Currently not available on the NHS for OCD.

Sertraline calms the chatter in my head regarding chronic overthinking and I'm lucky to be talking to a therapist through a charity.The therapist's are voluntary.

This is interesting. Are you referring to alternative therapies being used to treat mental health issues?

I’d be really interested if you have any articles to share. I am not aware of much being researched on OCD but might have missed it

Therapy is expensive though. I pay £52 a week for a 50 minute session. My medication is £9.60 a month.

Plus, lots of people won't (can't) engage with therapy until they're on medication anyway, so the NHS would have to fund both. I was offered talking therapy when I went on Paroxetine but my GP basically told me not to waste my time as they don't specialise in autistic adults and it could potentially do more harm than good.

We also don't know how anesthetic works. Escitalopram saved my life

I’m not autistic but I have also heard that some “traditional” talking therapies are not well-suited to autistic people. I’m not sure why that is, maybe different ways of thinking and communicating. For OCD gold standard therapy is CBT/exposure therapy but there are often long waiting lists. Without this support people with OCD can spiral and get worse and worse. As far as I know, the NHS doesn’t offer talking therapy for OCD to get at and maybe resolve root causes.

You can prise sertraline from my cold dead hands. Im just a nasty, vicious, short tempered mess without it

I personally think that they are overpresribed. After working in services, I truly don't believe we can medicate away the effects of things like trauma, bereavement, etc. I think the best antidepressants do in these situations is put a plaster over a wound and balance you out enough to engage in therapy.

The issue is that long term therapy (which is what most people with trauma need) is not available on the NHS. CBT in my experience is also not adequate for trauma. I say this as both a MH professional and as someone who has had years of psychodynamic therapy for trauma.

Sexual dysfunction is actually a well known side effect of SSRIs, and that's really up to the patient whether the benefits outweigh the cons. The problem with antidepressants is that it's hard to measure as the benefits are very subjective.

Antipsychotics are a bit more clear cut, as the outcome is a reduction in psychotic symptoms. And when they work, they work very well.

Depression is caused by many things (genetic, your internal working model/how your psyche processes things/trauma/grief, etc) so it's harder to treat in some ways.

There just aren't real alternatives on the NHS. CBT is fine for mild anxiety. It is woefully inadequate for things like PTSD. So what other option, other than to prescribe and hope for the best?

What is a true sense of the pros and cons?

Do you mean like a probability you will have a side effect? Giving that number is not going to help people who start SSRIs because of say anxiety because they will be convinced that they are the x% who get a certain side effect. Also for most people, it doesn’t matter if say 0.5% get headaches because most people will be in the 99.5% who don’t.

It’s hard to test what is feeling better when it comes to mental health. For some people it will be having enough energy to get out of bed and take a shower, for others it will be being able to go back to their stressful job and not have feelings or self harm.

Plus there’s the obvious problem of working out if someone is struggling to come off tablets because of a problem with the tablets or if it’s their original mental health issue returning. Not a doctor but do they know the difference ?

Psychedelic drugs are likely to come with an awful lot more side effects!

Speaking as someone who's taking multiple drugs with a much wider range of receptor actions (and hence side effects) than SSRIs and has had a lot of ECT I really wish SSRIs had relieved my illness. However, I'm also very grateful for the treatment I've had which has allowed me to carry on my life, side effects and all.

Sertraline nearly killed me. I will never ever go near another SSRI or SNRI ever again

All drugs will effect people differently. Topiramate nearly killed me awful drug if I had my way it would be banned but for some it works and is the best drug ever.

@Nocd39 ultimately the issue is that the NHS don't have unlimited funds to pay for years of therapy for everyone that needs it, so they offer medication (cheap) plus six weeks of therapy instead, as it means more people can at least access some kind talking treatment.

As PP's have said, the issue with medication is that everyone responds differently. I've been on sertraline and citalopram in the past and they both just led to horrendous weight gain, sexual dysfunction and emotional numbness. Apart from the settling in period, the only negative side effect I have from Paroxetine is that it makes me sweat more.

Other people have awful experiences on Paroxetine and will find Sertraline is what they need - it's just totally random, unfortunately.

All SSRI's are different.

I had an awful experience on Sertraline and went cold-turkey off it in the end. Now on Paroxetine and it's a total game-changer.

Thank you for sharing this is a really interesting insight. Why do you think other options like longer-term therapy aren’t available? Do you think it’s cost-driven? Are you aware of any research into the frequency/likelihood on sexual dysfunction and/or withdrawal problems? I think part of the problem is not knowing how likely you are to have these issues-a 1 in 10 chance is very different to a 1 in 100. But also people are often in really desperate situations, I know I was, and if there isn’t an alternative offered to an SSRI what else can they do?

I guess there’s a wider question here about what we value spending money on as a society and how we prioritise spending. Lots of medical treatments are very expensive but we pay for those. I know that NICE follows guidelines/criteria about how/what to spend on but there still seems to be a disparity in treatment for physical snd MH conditions.

I can’t take any medication that effects serotonin due to serotonin syndrome .. reality is I have been through talking therapies , I am now too complex for primary care so am under the Cmht ..

i know if i could take them antidepressants would help . Therapy for me without medication is an increased risk for me.

I’m sorry you also have problems with the medication. Lots of people don’t find SSRIs work for them or they can’t take them for various reasons so it would be great if there were alternatives available

Not in my experience. I'm lucky to be alive. I stopped them sharpish after 3 months and 3 suicide attempts. This was 25yrs ago.

I suspect they turn a blind eye to all the damage they cause some people because it's happening to people who are depressed.

I guess the issue is that for many people therapy is lifelong - can the NHS really fund it forever?

They don't damage everyone though.

All medications have side-effects, it would be impossible for them not to.